19 April 2020 (Sunday) - BTLP-TACT Exercise

Time for another BTLP-TACT exercise…

I was presented with two cases:

40959 – a ninety-year-old man needing a group and save as a pre-operative workup 

This fellow had an indeterminate ABO group – cell group A; serum group O. Is this an A2 with anti A1 or a "cold" antibody such as anti-M?

The Rh group was clearly positive and the control negative.

The antibody screen was negative

23871 – a seventy-seven year-old woman also needing a group and save as a pre-operative workup.

I immediately rejected this one as the patient information on the sample bore no relation to that on the request form.

I got the green light

16 April 2020 (Thursday) - Transfusion Evidence Alert email

The Transfusion Evidence Alert email arrived in my in-box today. Sepsis related anaemia, transfusion requirement of a combat-medic, beta-thalassaemia…

ARTICLE OF THE MONTH The effect of tranexamic acid by baseline risk in acute bleeding patients: a meta-analysis of individual patient-level data from 28 333 patients  FX Ageron, et al. Br J Anaesth 2020. PICO Summary available

TOP ARTICLES Sepsis-related anemia in a pediatric intensive care unit: transfusion-associated outcomes M Elshinawy, et al, Transfusion 2020. PICO Summary Application of Different Commercial Tourniquets by Laypersons: Would Public-access Tourniquets Work Without Training? RC Portela, et al. Acad Emerg Med 2020 PICO Summary Combat Medic Testing of a Novel Monitoring Capability for Early Detection of Hemorrhage NJ Koons, et al.The journal of trauma and acute care surgery 2020 PICO Summary Iron Chelation in Transfusion-Dependent Patients With Low- to Intermediate-1-Risk Myelodysplastic Syndromes: A Randomized Trial E Angelucci, et al. Ann Intern Med 2020 PICO Summary A Phase 3 Trial of Luspatercept in Patients with Transfusion-Dependent beta-Thalassemia MD Cappellini, et al. N Engl J Med 2020 PICO Summary A systematic review and meta-analysis of traumatic intracranial hemorrhage in patients taking prehospital antiplatelet J Alvikas, et all. The journal of trauma and acute care surgery 2020 PICO Summary The effect of restrictive versus liberal transfusion strategies on longer-term outcomes after cardiac surgery: a systematic review and meta-analysis with trial sequential analysis HH Kashani, et al. Canadian journal of anaesthesia 2020 PICO Summary The effect of fibrinogen concentrate on postoperative blood loss: A systematic review and meta-analysis of randomized controlled trials Ng KT, et al. J Clin Anesth 2020 PICO Summary Prognostic factors for VTE and Bleeding in Hospitalized Medical Patients: a systematic review and meta-analysis AJ Darzi et al.Blood 2020 PICO Summary

16 April 2020 (Thursday) - Transfusion News email

The Transfusion News newsletter appeared in my in-box today… is COVID-19 transmissible via a blood transfusion?

SARS-CoV-2 Found in Blood—Is it Transfusion Transmissible?

April 15, 2020 Researchers in both China and South Korea have identified SARS-CoV-2 in routine blood donations. In China, 2,430 blood donations (1,656 platelet and 774 whole blood) collected between January 25, 2020 and March 4, 2020 were screened by real-time reverse transcription PCR for SARS-CoV-2; in addition, almost 5,000 samples collected between December 21, 2019 and January 22, 2020 were retrospectively tested. [Read More]

FDA Alters Blood Donor Eligibility Guidelines during COVID-19 Public Health Emergency

April 7, 2020 The U.S. Food and Drug Administration (FDA) issued four blood donor eligibility guidelines on April 2, 2020 to help alleviate blood shortages during the COVID-19 pandemic—one on alternative procedures for blood and blood components collected during the COVID-19 public health emergency and three others on HIV, malaria, and Creutzfeldt-Jakob diseases (CJD). [Read More]

15 April 2020 (Wednesday) - Common Knowledge?

It is common knowledge that cannabis has beneficial anti-cancer properties…

Or does it?

It would seem that reliable evidence is still lacking. Again I really must be sur ethat what I am doing and saying is based on proper science and not common knowledge…

15 April 2020 (Wednesday) - Splenic Function

We had a phone call yesterday. A front-line worker with coeliac disease has been advised by ... lets say "a prominent and respected organisation" to have her blood taken and a film examined for Howell Jolly bodies.

The rationale is that the absence of Howell-Jolly bodies will prove adequate splenic function for her to continue working in a front-line role during the current COVID-19 pandemic.

This seemed a rather strange request to me and all of my colleagues. I mentioned it to one of the consultants who laughed and said that it was complete nonsense… but just wait – in five years it will be standard practice. (He’s probably got a point).

I thought I might ask the wider blood-testing community their opinion so I posted on the Facebook Hematology Interest Group.

The responses came into three broad categories.

• There were a lot of rather stupid and irrelevant animated gifs.
• There was a lot of opinion from people who clearly didn’t know the first thing about the blood test in question.
• And there were a few posts which addressed my question whilst showing some understanding of the matter. But only a few.

There were several references to articles posted from people in the third category amazingly ten per cent of people with coeliac disease also have reduced splenic function. Perhaps we *will* be looking for Howell-Jolly bodies more often?

14 April 2020 (Tuesday) - Critical Green Inclusion Bodies

Look what I saw today… These were all the rage in work-related Facebook groups a year or so ago. Originally billed as “Green Crystals of Death”, these blue-green crystals are seen in the neutrophils of critically ill patients. I must admit I’ve been hunting for them ever since I first heard of them, and so far I’ve seen one. Only one. This one.

They are now known as “Critical Green Inclusion Bodies” (even though they look blue to me!). there’s a good primer about the things on Wikipedia, but I have a question. Bearing in mind that neutrophils have been studied for over a hundred years since Elie Metchnikoff first described them, why have these critical green inclusion bodies only been seen in the last few years?

13 April 2020 (Monday) - New is better...?

 

Here’s an interesting article from a new source of CPD I’ve started following. TheScientistDaily I can distinctly remember talk of Herceptin a year or so ago. I *think I blogged about it here but (I won’t lie) I can’t be bothered to dig through the archives to find what I said.

But this article has researchers questioning whether Herceptin is as good as it was billed, and if current clinical guidelines for classifying and treating breast cancer may be off the mark. New classification schemes may better identify those patients more likely to benefit from anti-HER2 treatment or point to therapies that might be more effective.

Perhaps not directly relevant to what I do, but it makes me wonder just how wonderful the latest “wonder treatments” actually are. And how long it will be before the new classification schemes are superseded?

I can remember reading that NASA refused to allow technology less than five years onto their space probes as they wanted tried-and-tested technology; it’s no good finding problems when the space probe is half the solar system away.